Dr. Walter Moscoso, MD.
Fellowship-trained retina specialist

This Diabetes is the leading cause of blindness among working-age Americans. The majority of blindness is preventable with proper treatment. Diabetes affects vision primarily by exerting damage upon the retina of the eye.

Retinal damage is termed "RETINOPATHY." Diabetic retinopathy occurs as a consequence of abnormalities that develop in the blood vessels of the retina. Two types of diabetic retinopathy exist - - NON-PROLIFERATIVE and PROLIFERATIVE. Non-proliferative diabetic retinopathy occurs when the Retinal capillaries, the smallest blood vessels, become "weak." This allows serum (the clear liquid portion of blood) to leak from within the capillary toward the substance of the retina. This results in swelling of the retina. the retina becomes sick and vision may be decreased on this basis. Patients may also notice distortion or difficulty reading when the swelling occurs in the center part of the retina, (the macula). the retina may also be affected by destruction of the capillaries within the retina. If that occurs, blood cannot reach the retina, and vision may be diminished on this basis also.

The advanced form of diabetic retinopathy is called proliferative diabetic retinopathy. When this occurs in the retina, new, abnormal blood vessels grow. These new blood vessels are very abnormal and fragile and they occur through a process known as neovascularization. They also can cause scarring. This means that the scarring can lead to decreased vision or blindness. The neovascularization can also allow bleeding to occur within the eye and the eye may become filled with blood. This may cause the appearance of floaters or even a sudden loss of total vision, depending on the extent of the bleeding. Advanced cases of proliferative diabetic retinopathy may result in scar tissue, pulling the retina in such a way as to detach it from its normal position. The retinal detachment that occurs then can cause a devastating loss of vision.

Most of the complications of diabetic retinopathy can be prevented with laser treatments to the retina, an in-office procedure which seals off the leaking vessels to minimize vision loss. Other laser treatments allow for regression of scar tissue, which can occur in more advanced stages of diabetic retinopathy. This is best done if the individual is seen at regular intervals, the diabetic retinopathy is monitored for progression AND BLOOD SUGAR LEVELS ARE WELL CONTROLLED. Many patients afflicted with diabetic retinopathy do not even realize that they have undergone significant damage in their eye until they lose a lot of vision. When this occurs, the loss of vision usually is irreversible.

One of the treatments for diabetic retinopathy is an in-office procedure which seals off the leaking vessels to minimize vision loss.

Part of the management of diabetic retinopathy may include fluorescein angiography, which is a dye injection test where dye is injected into the vein of the arm of the patient and pictures are taken of the circulation of the retina in one or both eyes. This gives Dr. Moscoso important information about the status of the diabetic retinopathy.

In certain individuals where the diabetic retinopathy is advanced, a vitrectomy surgery may be indicated to remove the scar tissue, blood, or reattach the retina if it has been detached.

With proper, routine eye examinations and prompt treatment, loss of vision may be prevented or diminished. The best treatment, however, is to maintain blood sugar levels as close to normal as possible. This is achieved by complying with the drug regimen and dietary restrictions that your medical doctor requires of you. Exercise also is of great benefit.

RISK FACTORS ASSOCIATED WITH SEVERE VISUAL LOSS FROM DIABETES 1. Hemoglobin A1C (%) greater than 8.3 2. Initial visual acuity poorer than 20/20 vision The lower the initial visual acuity reading is, the greater the risk of severe visual loss. 3. Extensive macular edema (swelling) The more macular edema that is seen in the eye, the higher the chances of having severe visual loss. 4. History of neuropathy increases the likelihood of having severe visual loss from diabetes. 5. Anemia Having a hematocrit reading (percentage) that is low increases the chances of severe visual loss. In men, this would be equal to a hematocrit less than 45, and in females, it is a hematocrit less than 40. Treating anemia by your primary care doctor is very important in diabetics. 6. Having increased triglyceride (lipids) If you are between 18 and 29 years of age and your triglyceride (mg per dl) is greater than 140, there is an associated increased chance of developing severe visual loss. 7. Low albumin (gram per dl) less than 3.5 is a risk for severe visual loss. 8. Hypertension If poor or inadequate control of hypertension has been found to be a risk for having severe visual loss from diabetes, high blood pressure should be controlled aggressively. The best person to ask about any of these abnormalities would be your primary care doctor. If you do not have a primary care doctor, Dr. Moscoso would be happy to recommend one for you. 9. Duration of Diabetes The longer you have Diabetes, the more likely you will develop severe visual loss. Dr. Moscoso, our retina specialist, uses modern techniques to treat patients with diabetic retinopathy at our Bradenton, Sarasota, and Sun City Center, Florida locations.